Problem: You are called to a regional hospital emergency department for a male patient who is experiencing an STEMI and requires cardiac intervention and emergent air transfer to a tertiary care hospital. Transport time by air will be 45 minutes.
Patient is a 55 year old male. He weighs 122 kg (269 lbs.)
Vital signs are as follows:
- HR 84
- BP 126/86
- Oxygen saturation 95% on 2L/min by nasal cannula
- Temp 37 degrees C
The nurse reports to you that prior to your arrival, the patient received 3 sublingual doses of nitroglycerine and his chest pain improved. He was placed on a nitroglycerine drip at 10 μg/min with a concentration of 100 mg/250 mL running at 3 mL per hour. He was given 324 mg of Aspirin and a 30.5 mg bolus of abciximab (ReoPro).
EKG reveals anterior STEMI with ST elevation in leads V3 and V4. A heparin drip was also initiated at 1000 units/hr using a concentration of 25,000 units/250 mL running at 10 mL/hr.
You prepare to transfer the medications over to your transport pump. Are the above medication dosing calculations correct?
Discuss what are your responsibilities as the transport medic taking over care of this patient.
How many anticoagulant medications is the patient now on? What is the risk of this and how should you manage potential complications during transport?